Predicting discharge walking function with high-intensity stepping training during inpatient rehabilitation in non-ambulatory patients post-stroke

Abstract Objective This cohort investigation identified primary predictors of discharge walking function of non-ambulatory individuals post-stroke with high-intensity training (HIT) during inpatient rehabilitation. Design Observational cohort investigation. Setting Inpatient rehabilitation. Participants Data were collected from 257 individuals Intervention Clinical physical therapy interventions attempted to maximize stepping practice at higher intensities (HIT). Main outcome measures Primary outcomes included the discharge level of assistance required during walking (minimal or no assistance) and attainment of specific gait speed thresholds (0.4 and 0.8 m/s) during the 10-meter walk test (10MWT). Independent predictors were demographics, training interventions (including steps/day), baseline Berg Balance Scale (BBS) and paretic leg strength. Results Participants performed a median (IQR) of 1270 (533-2297) steps/day throughout inpatient rehabilitation, with significant differences between those who walked with vs without assistance at discharge. Logistic regressions indicate steps/day was a primary predictor of unassisted walking recovery; removal of steps/day resulted in primary predictors of baseline BBS and strength. Receiver operating characteristic (ROC) analyses indicate significant areas under the curve for BBS, and relatively low cut-off scores of 5.5 points at admission to walk without assistance at any speed. ROC analyses performed using 1-week outcomes indicate BBS scores of 5-17 points were needed to achieve locomotor thresholds. Conclusion Stepping activity, BBS and paretic leg strength were primary predictors of walking outcomes in patients performing HIT, and ROC analyses indicated recovery of independent walking could be achieved in low functioning patients early post-stroke.